Phakomatosis Pigmentovascularis: A Rare Disease.

A 19-year-old female, Mrs. XYZ, resident of Mumbai came with complaints of fever and cough with whitish expectorate of 12 days duration. The patient had a bright red erythematous patches on bilateral cheeks and chin (Fig. 1). Hyperpigmented patches seen over the body at multiple sites since birth.

Double - Trouble- Relapsing Leishmaniasis in a Virologically Suppressed HIV Positive Patient.

We present a case of a middle aged male, with long standing retroviral disease on second line ART (Anti-Retroviral Therapy) with three episodes of visceral leishmaniasis diagnosed on bone marrow examination treated with a combination of liposomal amphotericin B and miltefosine.

Indian Adolescent Living with HIV-AIDS: Current Clinical Scenario.

INTRODUCTION: Statistics suggest that, HIV has now largely become the disease of young patients. Hence, the adolescent HIV/AIDS needs to be handled and managed separately from adult HIV. Relatively fewer Indian data exist to characterize the associations in adolescents and young adults infected with HIV disease. The present study explores the current challenges in the management of HIV infected adolescents. OBJECTIVE: The study was aimed at evaluating, relationship between CD4 count and duration of antiretroviral therapy (ART), effects of ART on body mass index and the adverse effects of antiretroviral drugs in adolescent HIV positive patients. METHODS: This was a cross-sectional study involving 60 HIV positive adolescent patients attending tertiary care Institute KEM Hospital, Parel over duration of one year conducted at Mumbai. Patients on ART between age group 12 to 19 years. ART naïve patients were excluded from the study. RESULTS: 60 adolescent HIV positive patients attended our OPD including 37 males (61.67%) and 23 females (38.33%).The most common mode of transmission was vertical (80%). Education level was: school dropouts - 15%, primary education - 30%, Completed SSC - 31.7%, higher secondary - 23%. Among ADRs were 12 (63.15%) cases of anaemia due to Zidovudine, 4 (21.05%) hepatitis due to Nevirapine, 2 (10.52%) Tenofovir induced AKI and 1 (5.26%) Nevirapine rash. Wilcoxon matched pairs test showed a highly significant increase in the BMI (p <0.0001) post therapy. The mean CD4 of the patients at baseline and current presentation was 295.57 ± 109.81 and 630.93 ± 188.70 cells/mm3 respectively. The CD4 count was seen to be increasing with the increase in the duration of HAART treatment. CONCLUSIONS: High efficacy of HAART and availability of free ART under government programme has increased the duration of survival of the adolescent population with HIV. Treatment with HAART showed a favourable response with a statistical significant increase in CD4 count. Longer the duration of HAART, higher was the gain in CD4 count. Indian adolescent receiving long term ART, Lipodystrophy is not a troubling issue. Indian adolescent seems to be more tolerance of ART than the other parts of world.

A Study of Clinical Profile of Patients presenting with Complications of Acute Febrile Illnesses During Monsoon.

BACKGROUND: The objective of this study was to describe clinico-laboratory profile and outcome of complicated acute febrile illnesses among inpatients in a tertiary care hospital during monsoon. METHODS: This was an observational, prospective study conducted in a tertiary care hospital in Mumbai, India. Between July 2016 to October 2016, adult patients admitted to the hospital with complicated acute febrile illness were included. Demographic, clinical and laboratory data were collected and analyzed for each patient. Associations were sought between death and organ specific complications. RESULTS: Out of 276 patients enrolled male gender 187(67.8%) and age group of below 35 years comprised the larger proportion of the cases with total 115(63.2%) dengue,37(80.4%) leptospirosis, 25(69.4%) malaria cases. The most common symptoms reported amongst the enrolled patients included generalized body ache (85.9%), headache (77.4%), vomiting (73.4%), abdominal pain (50%), high coloured urine (34.2%), and breathlessness (32.1%), loose motion (25.1%) and altered Sensorium (8.8%). Clinical signs seen and significantly associated were pedal edema 14.5% (P=0.001), icterus 20.7%(P=0.0001) and tachypnoea 19.4%(P =0.001). Most common complication of dengue was shock (70.9%) followed by hepatic (66.5%) and haematological (65%) derangements, that of malaria was CNS involvement (29.4%), and for leptospirosis it was renal failure (45.9%) followed by respiratory distress (22.3%). Overall mortality in Dengue was 7(3.8%), malaria 2(5.6%), leptospirosis 15(32.6%), Hepatitis E 2(50%). CONCLUSION: The similarity in clinical presentation and diversity of etiological agents demonstrates the complexity of diagnosis and treatment of acute febrile illness. This study of clinico-laboratory profile of complicated febrile monsoon illnesses will be helpful to reduce mortality associated with monsoon illnesses by early referral and prompt treatment. Dengue and leptospirosis remain the commonest etiologies and major killer due to respiratory and renal involvements.

Evolution of Anti- Retroviral Therapy: Multiple Pills to Fixed Drug Combinations.

INTRODUCTION: First anti-retroviral drug available for the treatment of HIV/AIDS patients was Zidovudine (AZT) in 1986.1 AZT monotherapy was the only available ART and it resulted in early resistance to AZT.2 Hence there was a need for new antiretroviral drugs to treat HIV/AIDS. With a rapid development in research many new drugs came in the market. At present more than 25 antiretroviral drugs are available for the treatment of HIV/AIDS. With advancement in research and availability of RCTs results, it is evident that triple drug therapies are the only option for the treatment of HIV/AIDS to avoid early resistance. With the availability of newer and better drugs, older drugs like zalcitabine, delaverdine, stavudine were discarded. Older protease inhibitors (PIs) like indinavir, saquinavir are also being used less frequently due to availability of better PIs.

Syncope in a patient being treated for hepatic and intestinal amoebiasis.

A 63-year-old man presented to our hospital with amoebic liver abscess and was treated successfully for the same. During the course of his treatment, he developed syncopal attacks and was found to have Torsades de Pointes on electrocardiogram. The patient was treated with intravenous magnesium and direct current cardioversion. Hypokalaemia, chloroquine and sepsis were suspected to have precipitated the arrhythmia. The patient remained arrhythmia-free following the correction of these factors.

Clinical profile of severe Plasmodium vivax malaria in a tertiary care centre in Mumbai from June 2010-January 2011.

BACKGROUND: Plasmodium vivax is the most widely distributed human malaria parasite with an at risk population of 2.5 billion persons. With the implementation of molecular diagnosis, it has become evident that P. vivax monoinfection could also result in multiple organ dysfunction and severe life-threatening disease as seen in P. falciparum infection. AIMS AND OBJECTIVES: To note the clinical profile of patients with severe vivax malaria with regards to demographic, clinical and biochemical profile and its outcome. To compare the profile of falciparum malaria with vivax malaria. METHOD AND MATERIAL: We recruited 711 patients fulfilling the criteria for severe malaria during the study period from June 2010 to Jan 2011. Detailed history and examination findings were noted in all the patients. All the patients were subjected to routine haematological and biochemical investigations. The end points were discharge from wards or death due to malaria. RESULTS: We had 711 patients with severe malaria of which 488 (68.53%) patients had severe vivax and 223 (31.32%) had severe falciparum malaria. Amongst vivax group, 351 (71.92%) were males and 137 (28.07%) females. Thrombocytopenia (89.13%) was the most common complication followed by renal (31.96%), hepatic (19.46%) cerebral (8.19%) and pulmonary (1.63%) involvement. Most patients were in the age group of 21-30 years and mortality increased with increasing age. The mortality observed in severe vivax malaria was 9.01% (44/488), as compared to falciparum malaria where it was 16.14% (80/223). CONCLUSIONS: Severe vivax malaria is now very common with increasing mortality. The mortality in vivax malaria increases with increasing age. Thrombocytopenia is very common in severe vivax infection. Also, renal, hepatic, lung and cerebral involvement are also occur with increasing frequency. Along with age, severe metabolic acidosis is an independent risk factor for fatal outcome.